Knowing Premature Ejaculation - PART 2: Diagnosis, Types & Causes

As many as 30-40 % men across the world including India experience problem of PE at some time of life. In Part 1, we learnt about the condition called Premature Ejaculation (PE). In this 2nd part, let’s understand about it’s diagnosis & types of PE - why and how it happens.

How to Diagnose PE:

The specific criteria for premature (early) ejaculation are as follows:
- In almost 75-100% sexual activity, the experience of ejaculation occurring during sexual intercourse within 1 minute after vaginal penetration and before the individual wishes it.
- The problem has persisted for at least 6 months and is a cause of mental stress to the person.
- The dysfunction cannot be better explained by any other nonsexual mental disorder, any medical disease, the effects of a drug or medication, etc
 
Severity of PE:
 
The severity of premature (early) ejaculation is broadly defined as follows:
1. Mild (occurring within approximately 30 seconds to 1 minute of vaginal penetration)
2. Moderate (occurring within approximately 15-30 seconds of vaginal penetration)
3. Severe (occurring even before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration). In such cases conception will not be possible unless artificial insemination is used.
 
TYPES and Characteristics of P.E. :
Premature ejaculation can be Chronic (lifelong) or Acquired (recent).
Chronic PE:
With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post puberty). 
Acquired PE:
Acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and only recently has developed PE.

What are the Causes?
The causes of PE can be divided into two broad sub-heads, which are psychological or biological cause:
 
 
1. Psychological Causes:
Premature ejaculation is believed to be a psychological problem and does not represent any known organic / physical disease involving the male reproductive organs or any known defect in the brain or nervous system. It is usually due to a pattern that is hard to change and is a result of your previous sexual experiences.
 
One of the most common reason is childhood habit of reaching climax/ ejaculation quickly because of fear of discovery when masturbating or during early sexual experiences with a female partner. This pattern of rapid attainment of sexual release is difficult to change in later stage of life (in marriage or long-term relationships).
 
Other reasons are situations in which one may have hurried climax/ ejaculation in order to hide any problem or feelings of guilt that make you rush through sexual encounters. Also, psychological causes include anxiety and relationship issues which can also result from deep anxiety about sex that relates to bad experiences encountered by the patient during development (eg: incest, sexual assault, conflict with parents, etc ).
 
2. Biological Causes
 
A number of researchers have found differences in nervous stimulations and hormonal differences in men who experience premature ejaculation compared with individuals who do not.
 
Some believe that some men have hyper-excitability or oversensitivity of their genitalia.
 
Abnormal functioning of the ejaculatory system can be attributed to:
- Thyroid problems; infection or inflammation of the urethra or prostate.
- Nerve damage occurring due to trauma or surgery (a very rare cause).
- Abnormal levels of hormones and/or neurotransmitters (chemicals present in the brain)
- Higher free and total testosterone levels or varied other biochemical markers
*The research however has been non-conclusive.

In Part 3 and 4, we will discuss the right approach and therapy for the men / couple suffering due to PE.



Knowing Premature Ejaculation - PART 2: Diagnosis, Types & Causes

All you need to know about Premature Ejaculation

Many of the sexual issues are primarily not big problems. However, because of the taboo and inhibition around them, they are not discussed openly, hence they also fail to get resolved and become bigger. In fact most of the times there are no visible symptoms of any functional problems. Many of them are very basic issues and because of ignorance, myths, and social taboos lead to development of anxieties, distress and further worsening of the problem.

Often men are concerned about their performance in bed with their partner. They worry about- how best then can do, masturbation habits, size of penis and sperm quality. 

Consequences of Premature ejaculation (PE): 
Both you and your partner may end up experiencing highly unsatisfactory sex. In fact, it can significantly increase anxiety, which may deteriorate the problem. 

PE is one such sexual issue. It's not a disease; Not at all..!! 
If a person is sexually fit and experiences normal erections but just fail to hold the orgasm/ discharge for reasonable time then he is suffering from premature ejaculation. It's  a very normal problem, which if managed properly it can be easily resolved.

We will discuss this PE in 4 parts covering: what it is in actual, how does it happen, how to approach to resolve this problem with behavioural methods, exercise, techniques and medical remedies present in both modern and alternative medicine. 
Let s understand the problem in this 1st part!

What is Premature Ejaculation? 

Premature (early) ejaculation also referred to as rapid ejaculation; also called as early discharge. 
PE is the most common type of sexual dysfunction in men younger than 40 years and seen across all age groups. In elderly men (>60 years) erectile dysfunction is more common. A study conducted by the Journal of Sexual Medicine revealed that this condition is almost equally prevalent in sexually active men of all age groups. 
If a man experiences uncontrollable ejaculation (discharge of semen from your penis) either before or shortly after sexual penetration (usually within 1-2 minutes of penetration), he may be suffering from PE. The Mayo clinic at the United States defines PE as a condition in which  a man  always or nearly always ejaculates within one minute of penetration."

Instances of PE:
An occasional instance of premature ejaculation might not be cause of concern, but, if the problem occurs more than 50% of attempted sexual relations signifies existence of abnormal pattern for which treatment is required.

Premature ejaculation takes place with negligible sexual stimulation and even before the desire 
to ejaculate. Another way of describing PE by most therapist or clinicians is the occurrence of ejaculation sooner during sexual intercourse than he or his partner would like. 

This broad definition thus avoids specifying a precise  normal  duration for sexual activity and reaching a climax. The duration of sexual activity is highly variable and depends on various factors specific to each individual. Take a situation, a male may reach orgasm after 7 to 8 minutes of sexual intercourse, but if his partner is able to achieve climax mostly in 5 minutes and both are satisfied with this timing, then this is not defined as PE. 

Alternatively, a male might delay his ejaculation for up to 15- 20 minutes of sexual intercourse, but if his partner, even with foreplay, requires 25-30 minutes of total sexual activity before reaching climax, he may still consider his ejaculation premature because his partner has not been satisfied (at least, not through intercourse). But in routine practice this kind of situation is NOT called as PE. So every individual and every couple is unique. Same individual may have different sexual behaviour with different partners and different circumstances. Varied situations and varied places of performing the act have a vital role to play in determining the outcomes of individual sexual performance/s.



Knowing Premature Ejaculation - PART 1: Understanding What is PE

5 mind reasons you might not be getting an orgasm

Sex is not only a physical need, sex is a great way to emotionally bond and get closer to your partner as well. Any dissatisfaction in the bedroom can affect other aspects of your life, and can lead to fights, squabbles and general unhappiness. The inability to orgasm can become a major bone of contention. There can be various reasons behind the inability to climax. Some of the common ones are detailed below:

1. Lack of stimulation

Studies show that only 25% of women reach climax during sexual intercourse. The remaining 75% of women require more stimulation, like fingers or even toys and tongues to reach orgasm. Amongst this is a subset of 10-15% of women who never reach orgasm. Thus, a large number of women require extra stimulation to achieve climax during sex. You must talk to your partner about putting in some extra effort and providing the extra stimulation you need to achieve climax.

2. Over-thinking

Many men and women over-think their actions in bed. From their expressions to how they are reacting and how they are making their partner feel - everything is under constant scrutiny and revision. This leads to a lot of stress, which can hinder your ability to reach orgasm. You need to relax in the bedroom, because whatever you do will feel good in some way or another. Your anxieties can also distract you from what is going on, which means you don't get the chance to fully experience the pleasures of sex. If it helps, speak to your partner about your anxieties and tell them what you are stressing about during sex.

3. Differences between men and women 

Men are visual creatures. This means that what they see turns them on. A woman's orgasm, on the other hand, happens in her head. Thus, men and women have different roots to their stimulation. Lack of an orgasm might mean either of these needs isn't being fulfilled. A great way to work around this and make sex more fun is to include a lot of foreplay in your love-making session. You can do this by trying out role-playing or using sex toys. Make sure to take it slow for a great build-up to your orgasm.

4. Performance issues

Porn has an impact on your sex life. It can increase your expectations to a considerable extent, which may not be fulfilled, thus hampering your experience in the bedroom. A lot of people become so focused on reproducing that experience that they forget that its real life. The focus on performance overwhelms their actual experience of sex, which results in an inability to reach orgasm. Try to accept the fact that you don't really have to perform for your partner. Your partner appreciates you for what you are, despite everything.

5. Mental blocks

A problem in the relationship, certain health conditions like depression, past trauma and negative social conditioning can all have negative impacts on your ability to orgasm. Talk to your partner about past trauma if you have any, and what your triggers are. Consider speaking to a sex therapist as mental health issues should never be neglected. Depression hits the libido hard, and the problem is only compounded by antidepressants. Negative social conditioning can only be helped by therapy, so try to reach out to a mental health professional.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: Why You Must Try Kegel Exercises for a Happier Sex Life

5 Mind Reasons You Might Not Be Getting an Orgasm

8 Steps to a Happier Sex Life - Sex is probably the most important part of a relationship along with compatibility, trust and comfort. To make your relationship stronger and deeper, happiness in sex life is crucial. It must be the part of your life that you always look forward to and that brings the two of you together irrespective of the way your days go.

Follow these simple protocol to make for a happy sex life and therefore a happy life.

1) Believe you are sexy - Stop undermining yourself. You are sexy, accept it. And believe that your partner gets turned on by you. When you believe that your partner finds you sexy, you will be more interested in sex and so will your partner be.

2) Believe in the little gestures - Sex is not always awesome while you are in the act. The build up through the day can be made with the simplest of actions. A meaningful touch on the breakfast table, a mid-day text saying you miss him and an intimate evening message, or simply holding hands while shopping for grocery, all add up to build the connection between both of you.

3) Focus on the positive - Tell your partner what he does that you like. The kiss on the nape or how their breathe on your skin makes your senses tingle ? tell that. When your partner knows what you like, your bedroom experiments can take interesting turns. Always help your partner focus gently to what gives you pleasure.

4) Make time for sex - When new in a relationship, couples tend to have more sex and the frequency diminishes once they are comfortable in the situation. Avoid this; sex should be in your priority list at all times. Sex indeed should be a natural event. However, our lifestyles don't permit it. Also, there are too many distractions. If you need to schedule sex, it's okay. The idea is to indulge in it. You both have your needs and they should be fulfilled, right?

5) Fantasize - One great way to keep the passion alive is to share your fantasies. Doesn't matter how dirty it is, don't worry about what your partner will think. Far from judging, you yourself might realize something new about your partner. Chances are, that you might love the fantasies you both talk about.

6) Take it easy -  In real life, it is okay to not be perfect, to stop to catch breath and be real. To be happy with your sex life doesn't mean having spectacular sex every time. More than how you perform, it is how the experience was for both of you. Enjoy the process, it is for real.

7) Be responsive - Respond, even if you are not in the mood. Don't shun your partner because you are not in the mood. But if one of you wants to have sex, pushing them away is not a good idea. And if you still don't want to go ahead, explain that it's not them, but the time and plan to connect some time in near future.

8) Be willing to have sex - If you would rather watch tv all day rather than have sex and then do it nevertheless just because your partner initiated it, they would know. Never make your partner feel that you are having sex out of obligation. This is a mood killer and a guarantee for low satisfaction derived. Make sex an enjoyable affair, think what all you like and show them to your partner. 

If you have any further questions on sexual health, ask me by clicking on 'Consult'.

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Having Better Sex - 8 Steps to a Happier Sex Life

When Should You Use Viagra?

Viagra is a very common drug prescribed for treating erectile dysfunction. It works by enhancing the flow of blood to the penis during sexual intercourse to bring about erection. Viagra actually contains the active ingredient Sildenafil Citrate which is a selective inhibitor of Cyclic Guanosine Monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).

This drug works efficiently with sexual stimulation. Erectile dysfunction is very common among older men whose sexual function tends to fall after they reach their 50s. But these days even younger men in their 30's and 40's are experiencing an increased incidence of erectile dysfunction.

Doctors can even recommend the drug to both younger and elder men who suffer from erection problems.

Solidification of the arteries, the blood vessels that supply blood to the penis, can occur during the teen years. The problem then develops by the time they reach the age of 20-30 years and more, hindering their ability to get and maintain an erection. Men suffering from diabetes and facing the problem of Erectile dysfunction can be assisted by this drug.

The drug should be ideally taken an hour before the sexual intercourse.

On the other hand, you can also take Viagra half an hour to 4 hours before the sexual intercourse. You don't require having food in order to take the drug. But you need to keep in mind that if you take it after a meal high in fats, it can take a little bit longer for you to experience its effects.

Most importantly, the misuse of Viagra should be avoided. It should be taken only under medical supervision. The drug doesn't have the power to help you ejaculate easily if you suffer from problems related to orgasm or even enhance your sexual appetite. It does not enhance sexual timing, so should not be used to treat premature ejaculation. Men also shouldn't expect the drug to take the erections to unexpected heights.

Word of Caution:

One should never take the drug for recreational purposes. One can end up suffering from minor erectile dysfunction due such abuse.



When Should You Use Viagra?

5 reasons your partner doesn't want to have sex anymore

There are innumerable explanations as to why couples in long-term relationships find themselves in situations when either one of the partner's starts avoiding sex for a reason the other cannot comprehend.

The explanation for your partner's behaviour may be due to an underlying medical issue or various emotional or psychological factors. Following are a few reasons why your partner does not want to have sex anymore:

1. Physical factors: your partner might be experiencing a loss of libido due to physical ailments, particularly ones pertaining to the endocrine and circulatory systems. Disorders such as diabetes, hypothyroidism, heart complications to name a few, affect the hormone levels in the body, which leads to the lack of sexual drive.

2. Psychological factors: Many mental and emotional factors also affect libido in both men and women. Stress and depression, which often cause sleep deprivation, are two of the biggest causes of unwillingness to have sex. Talk to your partner about what the root of the problem is and ascertain what is creating stress and triggering depression. Communication and counselling are the main ways of dealing with such a situation.

3. Excessive masturbation: If a person watches too much pornography and consequently indulges in masturbation frequently, sexual function is automatically lowered when it comes to performing during intercourse. If your partner masturbates too much, simply ask that the practice needs to be put an end to.

4. Lack of affection: When there is a lack of warmth and affection between partners, the desire to engage in sexual intercourse is automatically diminished. Communicate with your companion to determine ways in which you can rekindle love and passion in the relationship.

5. Addiction to narcotics: If your partner has developed an addiction to certain narcotics, such as nicotine, morphine and various anti-depressants that reduce sex drive, it could be the reason for not wanting to have sex.

The reasons for developing an aversion to sex are often extremely subjective and complex. Open and honest communications between partners may unravel the problem but in many cases, therapy and medical assistance provides the solution.



5 Reasons Your Partner Doesn't Want to Have Sex Anymore

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